Provider Demographics
NPI:1497365654
Name:INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC.
Entity Type:Organization
Organization Name:INSPIRING CHANGE MENTAL HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ FOUNDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAQUANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER-DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-258-6714
Mailing Address - Street 1:4654 YORK RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4726
Mailing Address - Country:US
Mailing Address - Phone:410-258-6714
Mailing Address - Fax:
Practice Address - Street 1:4654 YORK RD STE 1A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4726
Practice Address - Country:US
Practice Address - Phone:410-258-6714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD677502100Medicaid